Survey of current and former welfare recipients, 2000

MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 1
CHAPTER VII: HEALTH CARE COVERAGE AND UTILIZATION
This chapter presents the survey findings on health care coverage among respondents,
including employer health insurance. The chapter also presents data relating to health care
utilization.
A. HEALTH CARE COVERAGE
· About 26 percent of respondents who had left welfare reported that they did not
have health care coverage for their children ( Exhibit VII- 1).
· The percentage who did not have health care coverage for their children was highest
among Native Americans, blacks, older respondents, less educated respondents, and
unmarried persons ( Exhibit VII- 2).
· The most common reason for not having health care coverage was that the
respondent thought they were no longer eligible for Medicaid ( Exhibit VI- 3).
· Another 27 percent mentioned problems related to participation in employer health
plans.
· About 61 percent of persons who had left welfare had Medicaid coverage and 6.2
percent had coverage through their employer ( Exhibit VI- 4).
EXHIBIT VII- 1
ARE YOUR CHILDREN COVERED UNDER MEDICAID OR ANOTHER
HEALTH PLAN? - BY CASE STATUS
Covered by Medicaid/
Other Health Plan?
Closed
Open
Yes 73.6% 98.0%
No 26.4% 2.0%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 2
EXHIBIT VII- 2
PERCENT OF RESPONDENTS WHOSE CHILDREN WERE NOT
COVERED BY HEALTH INSURANCE, BY SELECTED
CHARACTERISTICS
( CLOSED CASES)
Characteristic Percent
Ethnicity
Hispanic 23.4%
Caucasian 27.5%
Native American 32.5%
Black 35.7%
Employment Status
Working for pay 26.6%
Not working for pay 26.2%
Education
Did not complete high school or GED 27.8%
Completed high school or GED only 29.2%
Attended college 20.8%
Age
18- 24 24.5%
25- 29 24.9%
30- 34 22.3%
35- 39 27.2%
40+ 32.8%
Marital Status
Married and living with spouse 22.7%
Separated, divorced, widowed 29.7%
Never married 26.5%
EXHIBIT VII- 3
REASONS WHY RESPONDENTS DID NOT HAVE
HEALTH INSURANCE FOR THEIR CHILDREN
( CLOSED CASES)
Reason Percent*
No longer eligible for Medicaid due to income 27.8%
Can’t afford employer health insurance 12.3%
Employer does not provide health insurance 7.9%
Not eligible for employer health plan 4.4%
Employer health plan does not cover children 2.4%
Children turned 18 13.1%
Cut off Medicaid – does not know why 7.9%
* Percent of all cases without health coverage
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 3
EXHIBIT VII- 4
WHAT INSURANCE PLAN COVERS YOUR CHILDREN?
- BY CASE STATUS
Children’s Coverage* Closed Open
Medicaid 61.5% 96.8%
Employer health plan 6.2% 0.5%
Insurance from other parent 3.5% 0.8%
Indian Health Service 2.4% 1.1%
No coverage 26.4% 2.0%
* More than one response possible
B. EMPLOYER HEALTH INSURANCE
· Among employed persons in closed cases, about 24 percent were covered by an
employer health plan. Another 32 percent were working for employers with health
plans, but were not participating. About 38 percent were working for employers
who did not offer health plans ( Exhibit VII- 5).
· Of those persons working for an employer with a health plan, 43 percent were
participating in the plan, and 57 percent were not ( Exhibit VII- 5).
· In closed cases, the most common reasons for not participating were that the
respondents had not worked for the employer long enough to qualify and that the
cost of the premiums was too high. Another 17 percent did not qualify because
they were part- time or temporary employees ( Exhibit VII- 6).
· Although “ still on Medicaid” was cited by 7.5 percent of the respondents in closed
cases, many more of these respondents were actually on Medicaid but did not cite it
as a reason for not participating in their employer’s health plan.
· In cases no longer on welfare, the percentage of employed persons participating in
employer health plans varied significantly by occupation and type of employer. As
indicated in Exhibit VII- 7, teachers and other professionals were the most likely to
be covered by employer health plans. Persons working in unskilled or semi- skilled
occupations in sales or services were the least likely to be covered by employer
health insurance.
· As indicated in Exhibit VII- 8, persons working for government agencies, large
grocery stores, and schools or colleges were the most likely to be covered by
employer health insurance.
· Native Americans and persons who had not completed high school were the least
likely to be covered by employer health insurance ( Exhibit VII- 9)
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 4
EXHIBIT VII- 5
PERCENT OF EMPLOYED PERSONS WORKING FOR AN
EMPLOYER WITH HEALTH INSURANCE
( closed cases, working for pay)
Employer Health Plan Participation
Percent of Employed
Respondents
Employer has health plan and I am enrolled 24.1%
Employer has health plan but I am not enrolled 32.0%
Employer does not have health plan 38.1%
Self- employed, no health plan 5.8%
Total 100.0%
Percent participating in employer health plan if available 43.0%
EXHIBIT VII- 6
REASONS FOR NOT PARTICIPATING IN EMPLOYER HEALTH PLAN
( RESPONDENTS WORKING FOR EMPLOYERS
WITH HEALTH PLANS)
Reason for Not Participating Closed Open
Have not worked there long enough 31.6% 26.2%
Cost is too high 31.0% 24.3%
Part- time or temporary employee 17.1% 26.2%
Currently planning to apply 12.3% 3.9%
Still on Medicaid 7.5% 20.4%
Don’t know 4.8% 4.9%
Covered by Indian Health Service 4.3% 1.0%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 5
EXHIBIT VII- 7
PERCENT OF EMPLOYED PERSONS PARTICIPATING IN
EMPLOYER HEALTH INSURANCE PLANS, BY OCCUPATION
( closed cases, excludes self- employed)
Occupation Percent
Teacher 53.8%
Other professional 50.0%
Customer service 50.0%
Bus driver 50.0%
Security guard 44.4%
Assembly/ production 42.9%
Office clerk/ data entry 39.5%
Formworker 37.5%
Secretary 36.4%
Trades 35.3%
Administrative assistant 34.5%
Teacher’s aide 26.3%
Child care worker 21.4%
Janitor/ maintenance 21.4%
Kitchen help 20.0%
Nurse’s aide 18.2%
Cashier/ checker 15.4%
Restaurant worker 12.7%
Housekeeper ( motel/ home) 10.0%
Sales clerk 6.1%
EXHIBIT VII- 8
PERCENT OF EMPLOYED PERSONS PARTICIPATING IN
EMPLOYER HEALTH INSURANCE PLANS, BY TYPE OF EMPLOYER
( closed cases, excludes self- employed)
Type of Employer Percent
Government agency 56.3%
Large grocery store 47.4%
School/ college 46.4%
Casino 38.5%
Community organization 31.3%
Professional services firm 32.9%
Hospital/ health care facility 25.0%
Factory/ manufacturer 25.0%
Hotel/ motel 18.2%
Convenience store 14.8%
Construction firm 13.3%
Department store/ clothing store 12.5%
Other retail 9.4%
Restaurant 8.1%
Child care provider 7.7%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 6
EXHIBIT VII- 9
PERCENT OF EMPLOYED PERSONS COVERED BY
EMPLOYER HEALTH INSURANCE PLANS,
BY ETHNICITY AND EDUCATION
( closed cases, excludes self- employed)
Percent
Ethnicity
Hispanic 25.2%
Caucasian 27.6%
Native American 19.5%
Education
Did not complete high school or GED 15.2%
Completed high school or GED only 26.7%
Attended college 33.1%
C. REGULAR PLACE OF MEDICAL CARE
· About 97 percent of respondents in open cases and 88 percent of respondents in
closed cases reported that they had a regular place of medical care for their children
( Exhibit VII- 10). However, for about 7 percent of respondents in both closed and
open cases, the regular place for medical care was the emergency room.
· As shown in Exhibit VII- 11, there was not much difference between open and
closed cases in the percentage of persons using private doctors and HMOs.
EXHIBIT VII- 10
DO YOU HAVE A REGULAR PLACE TO TAKE YOUR CHILDREN FOR
MEDICAL CARE? – BY CASE STATUS WHEN SURVEYED
Regular Place? Closed Open
Yes -- private doctor,
clinic, HMO
81.1% 90.3%
Emergency room 7.1% 7.0%
No regular place 11.8% 2.7%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 7
EXHIBIT VII- 11
WHERE DO YOU TAKE YOUR CHILDREN FOR MEDICAL CARE?
-- BY CASE STATUS
Closed Open
Private physician 31.0% 33.5%
HMO 6.4% 8.1%
Clinic 43.2% 48.6%
Emergency room 7.1% 7.0%
Other 0.4% 0.1%
No regular place 11.8% 2.7%
Total 100.0% 100.0%
D. DISCUSSION
The fact that about 26 percent of former welfare recipients did not have health care
coverage for their children is due to a combination of losing eligibility for Medicaid and not
being able to find jobs that have health insurance. One strategy to deal with this problem is to
ensure that current and former TANF recipients are fully aware of transitional Medicaid
benefits as well as the benefits available under expanded Medicaid coverage for the working
poor.
Another strategy is to address the problem of employer health insurance by making
greater efforts to refer current welfare recipients to jobs that have health benefits. This may
involve developing special outreach programs to the types of employers who are most likely to
provide health plans. For example, such initiatives may involve greater use of customized
training programs designed to serve the specific needs of employers for certain job skills.

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Title from New Mexico Human Services Dept. web page -- heading above links to publication chapters in PDF.; No title page in PDF.; "... telephone surveys began in early November 1999."--p. I-1; As of 6/16/2005, web page also contains link to a 2002 publication of the New Mexico TANF longitudinal study.; Harvested from the web on 7/12/05

Transcript

MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 1
CHAPTER VII: HEALTH CARE COVERAGE AND UTILIZATION
This chapter presents the survey findings on health care coverage among respondents,
including employer health insurance. The chapter also presents data relating to health care
utilization.
A. HEALTH CARE COVERAGE
· About 26 percent of respondents who had left welfare reported that they did not
have health care coverage for their children ( Exhibit VII- 1).
· The percentage who did not have health care coverage for their children was highest
among Native Americans, blacks, older respondents, less educated respondents, and
unmarried persons ( Exhibit VII- 2).
· The most common reason for not having health care coverage was that the
respondent thought they were no longer eligible for Medicaid ( Exhibit VI- 3).
· Another 27 percent mentioned problems related to participation in employer health
plans.
· About 61 percent of persons who had left welfare had Medicaid coverage and 6.2
percent had coverage through their employer ( Exhibit VI- 4).
EXHIBIT VII- 1
ARE YOUR CHILDREN COVERED UNDER MEDICAID OR ANOTHER
HEALTH PLAN? - BY CASE STATUS
Covered by Medicaid/
Other Health Plan?
Closed
Open
Yes 73.6% 98.0%
No 26.4% 2.0%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 2
EXHIBIT VII- 2
PERCENT OF RESPONDENTS WHOSE CHILDREN WERE NOT
COVERED BY HEALTH INSURANCE, BY SELECTED
CHARACTERISTICS
( CLOSED CASES)
Characteristic Percent
Ethnicity
Hispanic 23.4%
Caucasian 27.5%
Native American 32.5%
Black 35.7%
Employment Status
Working for pay 26.6%
Not working for pay 26.2%
Education
Did not complete high school or GED 27.8%
Completed high school or GED only 29.2%
Attended college 20.8%
Age
18- 24 24.5%
25- 29 24.9%
30- 34 22.3%
35- 39 27.2%
40+ 32.8%
Marital Status
Married and living with spouse 22.7%
Separated, divorced, widowed 29.7%
Never married 26.5%
EXHIBIT VII- 3
REASONS WHY RESPONDENTS DID NOT HAVE
HEALTH INSURANCE FOR THEIR CHILDREN
( CLOSED CASES)
Reason Percent*
No longer eligible for Medicaid due to income 27.8%
Can’t afford employer health insurance 12.3%
Employer does not provide health insurance 7.9%
Not eligible for employer health plan 4.4%
Employer health plan does not cover children 2.4%
Children turned 18 13.1%
Cut off Medicaid – does not know why 7.9%
* Percent of all cases without health coverage
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 3
EXHIBIT VII- 4
WHAT INSURANCE PLAN COVERS YOUR CHILDREN?
- BY CASE STATUS
Children’s Coverage* Closed Open
Medicaid 61.5% 96.8%
Employer health plan 6.2% 0.5%
Insurance from other parent 3.5% 0.8%
Indian Health Service 2.4% 1.1%
No coverage 26.4% 2.0%
* More than one response possible
B. EMPLOYER HEALTH INSURANCE
· Among employed persons in closed cases, about 24 percent were covered by an
employer health plan. Another 32 percent were working for employers with health
plans, but were not participating. About 38 percent were working for employers
who did not offer health plans ( Exhibit VII- 5).
· Of those persons working for an employer with a health plan, 43 percent were
participating in the plan, and 57 percent were not ( Exhibit VII- 5).
· In closed cases, the most common reasons for not participating were that the
respondents had not worked for the employer long enough to qualify and that the
cost of the premiums was too high. Another 17 percent did not qualify because
they were part- time or temporary employees ( Exhibit VII- 6).
· Although “ still on Medicaid” was cited by 7.5 percent of the respondents in closed
cases, many more of these respondents were actually on Medicaid but did not cite it
as a reason for not participating in their employer’s health plan.
· In cases no longer on welfare, the percentage of employed persons participating in
employer health plans varied significantly by occupation and type of employer. As
indicated in Exhibit VII- 7, teachers and other professionals were the most likely to
be covered by employer health plans. Persons working in unskilled or semi- skilled
occupations in sales or services were the least likely to be covered by employer
health insurance.
· As indicated in Exhibit VII- 8, persons working for government agencies, large
grocery stores, and schools or colleges were the most likely to be covered by
employer health insurance.
· Native Americans and persons who had not completed high school were the least
likely to be covered by employer health insurance ( Exhibit VII- 9)
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 4
EXHIBIT VII- 5
PERCENT OF EMPLOYED PERSONS WORKING FOR AN
EMPLOYER WITH HEALTH INSURANCE
( closed cases, working for pay)
Employer Health Plan Participation
Percent of Employed
Respondents
Employer has health plan and I am enrolled 24.1%
Employer has health plan but I am not enrolled 32.0%
Employer does not have health plan 38.1%
Self- employed, no health plan 5.8%
Total 100.0%
Percent participating in employer health plan if available 43.0%
EXHIBIT VII- 6
REASONS FOR NOT PARTICIPATING IN EMPLOYER HEALTH PLAN
( RESPONDENTS WORKING FOR EMPLOYERS
WITH HEALTH PLANS)
Reason for Not Participating Closed Open
Have not worked there long enough 31.6% 26.2%
Cost is too high 31.0% 24.3%
Part- time or temporary employee 17.1% 26.2%
Currently planning to apply 12.3% 3.9%
Still on Medicaid 7.5% 20.4%
Don’t know 4.8% 4.9%
Covered by Indian Health Service 4.3% 1.0%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 5
EXHIBIT VII- 7
PERCENT OF EMPLOYED PERSONS PARTICIPATING IN
EMPLOYER HEALTH INSURANCE PLANS, BY OCCUPATION
( closed cases, excludes self- employed)
Occupation Percent
Teacher 53.8%
Other professional 50.0%
Customer service 50.0%
Bus driver 50.0%
Security guard 44.4%
Assembly/ production 42.9%
Office clerk/ data entry 39.5%
Formworker 37.5%
Secretary 36.4%
Trades 35.3%
Administrative assistant 34.5%
Teacher’s aide 26.3%
Child care worker 21.4%
Janitor/ maintenance 21.4%
Kitchen help 20.0%
Nurse’s aide 18.2%
Cashier/ checker 15.4%
Restaurant worker 12.7%
Housekeeper ( motel/ home) 10.0%
Sales clerk 6.1%
EXHIBIT VII- 8
PERCENT OF EMPLOYED PERSONS PARTICIPATING IN
EMPLOYER HEALTH INSURANCE PLANS, BY TYPE OF EMPLOYER
( closed cases, excludes self- employed)
Type of Employer Percent
Government agency 56.3%
Large grocery store 47.4%
School/ college 46.4%
Casino 38.5%
Community organization 31.3%
Professional services firm 32.9%
Hospital/ health care facility 25.0%
Factory/ manufacturer 25.0%
Hotel/ motel 18.2%
Convenience store 14.8%
Construction firm 13.3%
Department store/ clothing store 12.5%
Other retail 9.4%
Restaurant 8.1%
Child care provider 7.7%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 6
EXHIBIT VII- 9
PERCENT OF EMPLOYED PERSONS COVERED BY
EMPLOYER HEALTH INSURANCE PLANS,
BY ETHNICITY AND EDUCATION
( closed cases, excludes self- employed)
Percent
Ethnicity
Hispanic 25.2%
Caucasian 27.6%
Native American 19.5%
Education
Did not complete high school or GED 15.2%
Completed high school or GED only 26.7%
Attended college 33.1%
C. REGULAR PLACE OF MEDICAL CARE
· About 97 percent of respondents in open cases and 88 percent of respondents in
closed cases reported that they had a regular place of medical care for their children
( Exhibit VII- 10). However, for about 7 percent of respondents in both closed and
open cases, the regular place for medical care was the emergency room.
· As shown in Exhibit VII- 11, there was not much difference between open and
closed cases in the percentage of persons using private doctors and HMOs.
EXHIBIT VII- 10
DO YOU HAVE A REGULAR PLACE TO TAKE YOUR CHILDREN FOR
MEDICAL CARE? – BY CASE STATUS WHEN SURVEYED
Regular Place? Closed Open
Yes -- private doctor,
clinic, HMO
81.1% 90.3%
Emergency room 7.1% 7.0%
No regular place 11.8% 2.7%
MAXIMUS
Chapter VII: Health Care Coverage and Utilization Page VII- 7
EXHIBIT VII- 11
WHERE DO YOU TAKE YOUR CHILDREN FOR MEDICAL CARE?
-- BY CASE STATUS
Closed Open
Private physician 31.0% 33.5%
HMO 6.4% 8.1%
Clinic 43.2% 48.6%
Emergency room 7.1% 7.0%
Other 0.4% 0.1%
No regular place 11.8% 2.7%
Total 100.0% 100.0%
D. DISCUSSION
The fact that about 26 percent of former welfare recipients did not have health care
coverage for their children is due to a combination of losing eligibility for Medicaid and not
being able to find jobs that have health insurance. One strategy to deal with this problem is to
ensure that current and former TANF recipients are fully aware of transitional Medicaid
benefits as well as the benefits available under expanded Medicaid coverage for the working
poor.
Another strategy is to address the problem of employer health insurance by making
greater efforts to refer current welfare recipients to jobs that have health benefits. This may
involve developing special outreach programs to the types of employers who are most likely to
provide health plans. For example, such initiatives may involve greater use of customized
training programs designed to serve the specific needs of employers for certain job skills.